| NPI | 1295791408 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 003750) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 003750) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: GA 003750) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: GA 003750) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2012-02-01 |